Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Determination of polarity in noncentrosymmetric layer/substrate systems

Energy-dispersive anomalous X-ray scattering has been used for the determination of the polarity of a noncentrosymmetric layer/substrate system. The method was applied to an epitaxically grown (Ga,In)P layer on a (001) GaAs substrate as an example to show its applicability as a routine procedure for noncentrosymmetric thin-film systems. In the simplest case, four energy spectra of various orders of the 111 reflections were sufficient to identify polarity, without the need for intensity corrections

Topological Properties of the Peptide Bond in Glycyl-L-threonine Dihydrate Based on a Fast Synchrotron/CCD-Diffraction Experiment at 100 K

The charge density of glycyl-L-threonine dihydrate is extracted from a synchrotron data set of 98 405 reflections collected at 100 K with a Bruker CCD area detector up to a resolution of d=0.38 Å (sinθ/λ=1.32 Å−1). The data are interpreted in terms of the “rigid pseudoatom” model. The topology of the experimental density is analyzed and compared with the topology obtained experimentally for the constituting amino acids and to that derived from Hartree-Fock calculations for the isolated molecule. All critical points of the electron density at the covalent and hydrogen bonds, as well as those of the Laplacian, were located, thereby deriving quantitative topological data for the peptide and side chain bonds. Bond topological indices in the dipeptide compare well with those of the corresponding bonds in the building amino acids, thus suggesting transferability of electronic properties of atoms and functional groups when these are derived by Bader's partitioning. Discrepancies between theoretical and experimental results could be attributed to crystal field effects

Schnelle Experimente zur Ladungsdichtebestimmung: topologische Analyse und elektrostatisches Potential der Aminosäuren L-Asn, DL-Glu, DL-Ser und L-Thr

Synchrotronstrahlung und CCD-Detektion ermöglichten schnelle Beugungsexperimente, mit denen genaue Ladungsdichteverteilungen von Aminosäuren hergeleitet werden konnten. Ihre topologische Analyse (das Bild zeigt die negative Laplace-Funktion von DL-Serin in der Ebene der Carboxylatgruppe) liefert für die Aminosäuren nicht nur vergleichbare Informationen über intramolekulare, sondern auch über schwache intermolekulare Wechselwirkungen